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Therapiemonitoring im MRT unter neoadjuvanter Therapie

RECIST und funktionelle Bildgebung

Therapy monitoring of neoadjuvant therapy with MRI

RECIST and functional imaging

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Zusammenfassung

Klinisches/methodisches Problem

Mit dem steigenden Einsatz der neoadjuvanten Chemotherapie bei Patientinnen mit einem primär operablen Mammakarzinom erlangt die frühzeitige Evaluation des Therapieansprechens eine zunehmende Bedeutung.

Radiologische Standardverfahren

Die klinische Untersuchung, die Mammographie und die Hochfrequenzsonographie der Brust weisen für das Therapiemonitoring eine hohe Interobservervariabilität auf.

Methodische Innovationen

Die Magnetresonanztomographie (MRT) bietet die Möglichkeit, neben der Tumorgröße und der Morphologie auch funktionelle Parameter zu erfassen und somit bereits früh im Therapieverlauf das Therapieansprechen vorherzusagen.

Leistungsfähigkeit

Ziel einer frühen zuverlässigen Prädiktion des Therapieansprechens ist die Abstimmung der Therapie auf die individuelle Patientin.

Bewertung

Der vorliegende Beitrag fasst die aktuellen Leitlinien zum Therapiemonitoring unter neoadjuvanter Chemotherapie des Mammakarzinoms gemäß den Response Evaluation Criteria In Solid Tumors (RECIST) zusammen, beschreibt die technischen Grundlagen des Therapiemonitorings mithilfe der funktionellen MRT und gibt einen Überblick über die aktuelle Studienlage zur klinischen Anwendbarkeit der funktionellen MRT im Rahmen des Therapiemonitorings.

Empfehlung für die Praxis

Die funktionelle MRT liefert im Rahmen von Studien vielversprechende Ansätze zur Evaluation des Therapieansprechens. Das Evidenzlevel ist für die dargestellten Verfahren der funktionellen MRT im Rahmen des Therapiemonitorings jedoch derzeit nicht ausreichend evaluiert.

Abstract

Clinical/methodical issue

Neoadjuvant chemotherapy is increasingly being applied in patients with operable breast cancer. Thus, an early prediction of response to neoadjuvant chemotherapy is of high relevance.

Standard radiological methods

The interobserver variability of clinical examination, mammography and ultrasonography in the assessment of response to neoadjuvant chemotherapy is high.

Methodical innovations

Magnetic resonance imaging (MRI) allows the assessment of functional parameters in addition to changes in tumor size and morphology.

Performance

A reliable therapy response monitoring aims at optimizing individualized patient care.

Achievements

This paper summarizes current guidelines for the assessment of response to neoadjuvant chemotherapy in breast cancer according to the response evaluation criteria in solid tumors (RECIST). Furthermore, the technical principles of MRI-based therapy monitoring are described and an overview of the clinical studies that have assessed the feasibility of functional MRI in response to treatment evaluation is given.

Practical recommendations

The technology of functional MRI offers promising results concerning therapy response monitoring. However, the level of evidence is not sufficiently evaluated for the technologies of functional MRI presented here.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Grandl, M. Ingrisch, K. Hellerhoff geben an, dass kein Interessenkonflikt besteht. Alle angewandten Verfahren stehen im Einklang mit den ethischen Normen der verantwortlichen Kommission für Forschung am Menschen (institutionell und national) und mit der Deklaration von Helsinki von 1975 in der revidierten Fassung von 2008. Alle Patienten wurden erst nach erfolgter Aufklärung und Einwilligung in die Studie eingeschlossen.

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  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    S. Grandl, M. Ingrisch & K. Hellerhoff

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  1. S. Grandl
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  2. M. Ingrisch
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Correspondence to S. Grandl.

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Grandl, S., Ingrisch, M. & Hellerhoff, K. Therapiemonitoring im MRT unter neoadjuvanter Therapie. Radiologe 54, 233–240 (2014). https://doi.org/10.1007/s00117-013-2576-4

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